Manitoba has highest rate of hospital deaths in Canada: report

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This article was published 29/11/2016 (814 days ago), so information in it may no longer be current.

A new national health report card gives Manitoba a couple of As, a couple of Fs and a few "needs more improvement."

First the good news. The Canadian Institute for Health Information (CIHI) 2015-16 report Your Health System released today says Manitoba is the only province where 100 per cent of cancer patients receive radiation treatments within four weeks, and data show Winnipeg personal care homes are below the national average in using chemical restraints on residents with dementia. Wait times in Winnipeg emergency departments are still nearly double the Canadian average but have dropped more than eight per cent in the last six months thanks to efforts undertaken earlier this year, Lori Lamont with the Winnipeg Regional Health Authority said Tuesday.

The WRHA vice president and chief nursing officer held a technical briefing for media in advance of the CIHI report that was embargoed until Wednesday morning. She said the report uses some "difficult" terminology, like referring to the 90th percentile when describing ER wait times. For example, the report says ER waits in the WRHA are 5.5 hours at the 90th percentile rather than looking at the median or 50th percentile, or the point at which 50 per cent of the data fall below that point, and 50 per cent fall above it -- which is just a two hour wait. Whether it's the 90th percentile or the median wait time that's measured, both are close to twice as long as the Canadian average and, Lamont conceded, still need improvement. They've set up rapid assessment zones and intake teams that are moving patients from the ER waiting room to the next intake area for tests or treatment and that's clearing clogged ERs. She said the WRHA wanted to get out front of the report's release to highlight improvements to emergency room care before the media got ahold of the report and honed in on just the bad news.

Bad news like Manitoba having the highest rate of hospital deaths in Canada. The "hospital standardized mortality ratio" (HSMR) outlined in the report says the national average for the 2015-16 year was 93. For Manitoba, it was 110. Saskatchewan had the lowest at 88.

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Hey there, time traveller! This article was published 29/11/2016 (814 days ago), so information in it may no longer be current.

A new national health report card gives Manitoba a couple of As, a couple of Fs and a few "needs more improvement."

First the good news. The Canadian Institute for Health Information (CIHI) 2015-16 report Your Health System released today says Manitoba is the only province where 100 per cent of cancer patients receive radiation treatments within four weeks, and data show Winnipeg personal care homes are below the national average in using chemical restraints on residents with dementia. Wait times in Winnipeg emergency departments are still nearly double the Canadian average but have dropped more than eight per cent in the last six months thanks to efforts undertaken earlier this year, Lori Lamont with the Winnipeg Regional Health Authority said Tuesday.

The WRHA vice president and chief nursing officer held a technical briefing for media in advance of the CIHI report that was embargoed until Wednesday morning. She said the report uses some "difficult" terminology, like referring to the 90th percentile when describing ER wait times. For example, the report says ER waits in the WRHA are 5.5 hours at the 90th percentile rather than looking at the median or 50th percentile, or the point at which 50 per cent of the data fall below that point, and 50 per cent fall above it — which is just a two hour wait. Whether it's the 90th percentile or the median wait time that's measured, both are close to twice as long as the Canadian average and, Lamont conceded, still need improvement. They've set up rapid assessment zones and intake teams that are moving patients from the ER waiting room to the next intake area for tests or treatment and that's clearing clogged ERs. She said the WRHA wanted to get out front of the report's release to highlight improvements to emergency room care before the media got ahold of the report and honed in on just the bad news.

Bad news like Manitoba having the highest rate of hospital deaths in Canada. The "hospital standardized mortality ratio" (HSMR) outlined in the report says the national average for the 2015-16 year was 93. For Manitoba, it was 110. Saskatchewan had the lowest at 88.

A spokeswoman for the WRHA said there are two major reasons for the difference in hospital death rates in Winnipeg, relative to the Canadian average.

"Winnipeg is a major referral centre for very ill patients from rural and northern Manitoba and northwestern Ontario. Given that very ill patients are more likely to be at risk of dying, this may partially explain the increased (hospital mortality) rates in Winnipeg hospitals," Anne Bennett said in an email.

The 'hospital standardized mortality ratio' of each province in Canada. The ratio average was set at 100 in 2012–2013 based on data collected from Canadian hospitals. It's calculated by dividing the number of actual deaths by the number of expected deaths and multiplied by 100.

"If a patient’s record is not correctly coded as having received palliative care, then the death is considered an unexpected death... If this is not done properly, then a patient who is expected to die may be incorrectly considered an unexpected death and wrongly counted in the HSMR statistic. We are working to educate clinicians regarding the use of these terms in medical records, so that patients are properly coded. We believe this may be a significant contributor to the HSMR statistic in Winnipeg," Bennett said.

The CIHI report says that since the mid-2000s, there have been efforts across Canada to deliver better and safer care to patients. From hand washing campaigns and better communication between hospital staff, to the creation of rapid response units to assist patients in sudden distress, steps have been taken that have lowered the number of hospital deaths from 103 in 2011-2012 to 93 this past fiscal year. The hospital standardized mortality ratio was first made public in 2007 and has been used by hospitals to see whether their improvement efforts are working and where there is room for improvement.

The ratio average was set at 100 in 2012–2013 based on data collected from Canadian hospitals, CIHI says. It's calculated by dividing the number of actual deaths by the number of expected deaths and multiplied by 100.

The other grim news is that Manitobans aren't expected to live as long as the average Canadian. In Manitoba, the life expectancy is 79.5 year, compared to the national average of 81.1 years.

One bright spot in the report is how many long-term care residents in Winnipeg are being given antipsychotic drugs to manage difficult behaviour. Often referred to as "chemical restraints," they're sometimes given to people with dementia. Health care providers and advocates have expressed concern about their overuse and the risk of serious side effects. The report looks province-by-province at what percentage of personal care home residents are being given antipsychotics when they've never been diagnosed with psychosis. Manitoba is one of a few provinces excluded. That's because only the Winnipeg Regional Health Authority tracks that information electronically and provides it to CIHI.

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In Winnipeg, the news is good. There's been a gradual decline in the use of chemical restraints - from 23.2 per cent of long-term care residents in 2012-13 to 21.3 per cent for 2015-16. The number of personal care home residents in Winnipeg receiving antipsychotic drugs is lower than the Canadian average of 23.9 per cent, the report says.

For those who advocate for Manitobans with Alzheimer's and dementia, a decline in the use of such drugs is promising.

"We are very aware of it in personal care homes across the province and want to see the amount of use of antipsychotics declining," said Norma Kirkby, program director for the Alzheimer Society of Manitoba.

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Norma Kirkby, program director at Alzheimer Society says a decline in the use of chemical restraints is promising.

"The downsides of them are pretty significant," Kirkby said. "That's why if people are prescribed them inappropriately it's really important to get them off of those," she said. "For some it's very significant. It affects their balance or their gait and can put them at increased risk of falls," she said. If people are overly-sedated "the person isn't as bright as they can be and it detracts from their quality of life," said Kirkby. When they're chatting with families, Kirkby said the society advises them to do all that they can to ask for non-pharmaceutical interventions on behalf of their loved one. They should ask that drugs only be used if there is an absolute need for them, and to to ask for the lowest dose possible. Sometimes the meds are needed if they're struggling with things like involuntary movements.

"Some people do have legitimate need for antipsychotics because a particular aspect of behaviour emerges. They might need a short stint to help them through it," said Kirkby. She'd like to see reporting on the use of antipsychotics at all personal care homes in Manitoba and greater transparency. The data is helpful when looking at personal care homes for a family member, she said. Still, nothing beats an in-person visit, she said. "When you walk in the door, how does it feel? Is it accessible and easy to visit your family member?"

carol.sanders@freepress.mb.ca

Carol SandersReporter

Carol Sanders’ reporting on newcomers to Canada has made international headlines, earned national recognition but most importantly it’s shared the local stories of the growing diversity of people calling Manitoba home.

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